NBME Step 2 CK Form 7 Intravascular volume depletion (NBME Answers)

NBME Step 2 CK Form 7 Answers

step2ck_form7/Block 1/Question#26 (reveal difficulty score)
A 47-year-old woman comes to the physician ...
Intravascular volume depletion 🔍 / 📺 / 🌳 / 📖
tags: endo inc

+6 upvote downvote
submitted by ∗jesusisking(31)

get full access to all content ⋅ pick a username

Did anyone else think autonomic insufficiency given the diabetes? I know it was previously well controlled but still a 10 year history

get full access to all content ⋅ pick a username

seagull ya dude. +

charcot_bouchard You wouldn't expect baseline low BP at that case. Also other features like fever suggest alt dx +

+3 upvote downvote
submitted by ∗step_prep5(246)

get full access to all content ⋅ pick a username

Middle-aged woman with potential infectious disease (fever) leading to one week of uncontrolled hyperglycemia who has signs of orthostatic hypotension (drop in systolic BP >20 or diastolic BP >10 when moving from sitting to standing) and is found to have glucosuria, most consistent with intravascular volume depletion due to glucose acting as an osmotic agent and leading to polyuria
Key idea: Infections often lead to increased insulin requirement by causing a reactionary hyperglycemia

https://step-prep.org/tutoring/

get full access to all content ⋅ pick a username

antwon Would this be stress hyperglycemia? meaning stress would lead to gluconeogenesis, glycogenolysis, and insulin resistance. Therefore more glucose in the urine and therefore glucosuria. +

+2 upvote downvote
submitted by ∗buttercup(18)

get full access to all content ⋅ pick a username

Osmotic diuresis caused by glucosuria is one of the most common causes of excessive renal salt and water loss.

get full access to all content ⋅ pick a username

russnels What would cause the acute increase in blood glucose concentrations? +1

study_dude_guy I think this question is getting at HHS. The glucose levels are way lower than typical HHS but the patient has a fever and WBCs in the urine so MAYBE a UTI (even though it doesn't say anything about UTI symptoms) +

+2 upvote downvote
submitted by ∗russnels(20)

get full access to all content ⋅ pick a username

I was initially thinking adrenal insufficiency, but that is wrong b/c you would actually expect to see HYPOglycemia, not worsened hyperglycemia. You would still expect to see hypotension, however.

get full access to all content ⋅ pick a username

+0 upvote downvote
submitted by ∗charcot_bouchard(574)

get full access to all content ⋅ pick a username

Adrenal insufficiency will cause - If primary (i.e loss of both cort and aldo) : u have refractory hypotension. not only postural

Only aldo loss (like drug induced) can cause postural drop but thats highly ulikely here and its not called adrenal insufficiency.

here, infection > Fever (both cause vasodilation)

Infection > stress hyperglycemia > oosmotic diuresis > Fluid loss

get full access to all content ⋅ pick a username

Must-See Comments from step2ck_form7

seagull on Analgesic therapy
athleticmedic on Uterine atony
seagull on Haemophilus influenzae
jlbae on Lorazepam therapy
seagull on Spondylolisthesis
carolebaskin on B lymphocyte
yotsubato on Indomethacin
yotsubato on Uterine atony
study_dude_guy on Bone marrow aspiration
chris07 on Heat stroke
osler_weber_rendu on Compression fracture
buttercup on Repeat blood pressure measurement in 4 weeks
step_prep5 on CT scan of the head
thajoker on Brisk rotatory nystagmus on left lateral gaze